Provider Demographics
NPI:1073563961
Name:THOMAS, EAPEN (MD)
Entity Type:Individual
Prefix:DR
First Name:EAPEN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BANDERA COURT
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-1401
Mailing Address - Country:US
Mailing Address - Phone:423-946-8668
Mailing Address - Fax:
Practice Address - Street 1:2 BANDERA COURT
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-1401
Practice Address - Country:US
Practice Address - Phone:423-946-8668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11937207RG0100X
WAMD60655687207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3170558Medicaid
TNB03410Medicare UPIN
TN3170558Medicare ID - Type Unspecified